Surgical treatment of refractory epilepsy after chemotherapy in two children with leukemia.

Leng Y, Yu T, Li Y, Chen W - Epilepsy Behav Case Rep (2013)

Bottom Line:
In these cases, the cause of the refractory seizures was identified as mesial temporal lobe sclerosis.Using presurgical evaluations and measures of the surgical outcomes, the lesions were identified as epileptogenic and were located in the mesial temporal lobe.The underlying pathophysiological background is discussed to aid in understanding this uncommon long-term complication.

ABSTRACTRefractory epilepsy is a rare, long-term complication in children with acute leukemia who are receiving chemotherapy. A few studies have reported cases of several patients who developed recurrent complex partial seizures after the initiation of chemotherapy. In these cases, the cause of the refractory seizures was identified as mesial temporal lobe sclerosis. Here, we report on two patients with extratemporal lesions accompanied by refractory seizures, a long-term complication of acute lymphocytic leukemia. Using presurgical evaluations and measures of the surgical outcomes, the lesions were identified as epileptogenic and were located in the mesial temporal lobe. The underlying pathophysiological background is discussed to aid in understanding this uncommon long-term complication.

Mentions:
Four years after the discontinuation of the antileukemic treatment, the patient had his first epileptic seizure. From then on, he experienced stereotyped seizures that lasted 2 to 3 min. The seizures were preceded by an aura that the patient described as a feeling of needing to urinate. During the seizures, the patient sat up and purposelessly moved his body, including movements of oral automatism, eye blinks, and tonic and clonic movements of his right face and right limbs. The seizures mostly occurred during sleep but occasionally occurred during the daytime. Several antiepileptic drugs, including topiramate, clonazepam, phenytoin sodium, carbamazepine, lamotrigine, and sodium valproate, were administered in the following years, but the outcome was always disappointing. When he was admitted to the hospital, his seizures were occurring several times per week. Interictal scalp electroencephalography (EEG) recordings revealed left temporal–occipital discharges, and long-term video-EEG monitoring revealed that the seizures originated from the same region. Magnetic resonance imaging (MRI) scans showed slight atrophy of the cortex in this region (Fig. 1). Long-term intracranial recording was performed to localize the epileptogenic focus and to more accurately map the functional cortex (Fig. 2). The interictal cortical EEG showed repeated spikes in the left temporal lobe, especially in the posterior temporal region. The ictal EEG showed that the seizures predominantly originated from the posterior part of the temporal lobe. Surgical excision of the epileptogenic tissue in the left temporal–parietal region was performed. The patient was seizure-free for the following two months. However, the seizures gradually reappeared two months after the operation. Six months later, after further preoperative evaluation, an additional resection was performed to remove the left anterior temporal lobe (4 cm in length), including 2 cm of the hippocampus. Since the operation, the patient has been seizure-free for over one year and is medicated with carbamazepine and lamotrigine. Postoperative histopathological examination revealed cicatrix and gliosis in the resected posterior temporal tissue (first resection) and neuronal loss and gliosis in the hippocampus (second resection).

Mentions:
Four years after the discontinuation of the antileukemic treatment, the patient had his first epileptic seizure. From then on, he experienced stereotyped seizures that lasted 2 to 3 min. The seizures were preceded by an aura that the patient described as a feeling of needing to urinate. During the seizures, the patient sat up and purposelessly moved his body, including movements of oral automatism, eye blinks, and tonic and clonic movements of his right face and right limbs. The seizures mostly occurred during sleep but occasionally occurred during the daytime. Several antiepileptic drugs, including topiramate, clonazepam, phenytoin sodium, carbamazepine, lamotrigine, and sodium valproate, were administered in the following years, but the outcome was always disappointing. When he was admitted to the hospital, his seizures were occurring several times per week. Interictal scalp electroencephalography (EEG) recordings revealed left temporal–occipital discharges, and long-term video-EEG monitoring revealed that the seizures originated from the same region. Magnetic resonance imaging (MRI) scans showed slight atrophy of the cortex in this region (Fig. 1). Long-term intracranial recording was performed to localize the epileptogenic focus and to more accurately map the functional cortex (Fig. 2). The interictal cortical EEG showed repeated spikes in the left temporal lobe, especially in the posterior temporal region. The ictal EEG showed that the seizures predominantly originated from the posterior part of the temporal lobe. Surgical excision of the epileptogenic tissue in the left temporal–parietal region was performed. The patient was seizure-free for the following two months. However, the seizures gradually reappeared two months after the operation. Six months later, after further preoperative evaluation, an additional resection was performed to remove the left anterior temporal lobe (4 cm in length), including 2 cm of the hippocampus. Since the operation, the patient has been seizure-free for over one year and is medicated with carbamazepine and lamotrigine. Postoperative histopathological examination revealed cicatrix and gliosis in the resected posterior temporal tissue (first resection) and neuronal loss and gliosis in the hippocampus (second resection).

Bottom Line:
In these cases, the cause of the refractory seizures was identified as mesial temporal lobe sclerosis.Using presurgical evaluations and measures of the surgical outcomes, the lesions were identified as epileptogenic and were located in the mesial temporal lobe.The underlying pathophysiological background is discussed to aid in understanding this uncommon long-term complication.

ABSTRACTRefractory epilepsy is a rare, long-term complication in children with acute leukemia who are receiving chemotherapy. A few studies have reported cases of several patients who developed recurrent complex partial seizures after the initiation of chemotherapy. In these cases, the cause of the refractory seizures was identified as mesial temporal lobe sclerosis. Here, we report on two patients with extratemporal lesions accompanied by refractory seizures, a long-term complication of acute lymphocytic leukemia. Using presurgical evaluations and measures of the surgical outcomes, the lesions were identified as epileptogenic and were located in the mesial temporal lobe. The underlying pathophysiological background is discussed to aid in understanding this uncommon long-term complication.